Compliance of devolved government hospitals to the PhilHealth Benchbook standards A Rapid Assessment

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Compliance of devolved government hospitals to
the PhilHealth Benchbook standards(A Rapid
Assessment)

• Amador R. Catacutan, MD, MHA, MPhil-IPH
• Adviser, Local Health Systems Development
• Ferdinal M. Fernando, MD, MDM
• Senior Technical Coordinator
• German Technical Cooperation

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Introduction

• Quality assurance in health
• Brings greater client satisfaction
• Achieves better health outcome
• Increases effectiveness and efficiency
• Assessment of quality performance
• Establish baseline studies
• For continuous quality improvement
• Objective self-assessment process

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Introduction

• Section 50 of the Revised Implementing Rules of
  the National Insurance Act (RA 7875) as amended
  by RA 9241 mandates the Philippine Health
  Insurance Corporation to implement the Quality
  Assurance Program for hospitals
• PhilHealth Circular No. 12, s 2005 adopted
  PhilHealth Benchbook on Performance Improvement
  of Hospital Services to assess and evaluate the
  performance of the facilities based on quality
  standards
• PhilHealth Circular No. 12, s 2006 requires all
  hospitals applying for accreditation to have a
  Continuous Quality Improvement Program beginning
  January 2007

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PhilHealth Benchbook
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Objectives of the Study

• To assess the compliance of devolved government
  hospitals in operationalizing the PhilHealth
  Benchbook
• To enumerate the most common causes of partial
  and non-compliance to the standards
• To evaluate the applicability of partial and
  non-compliant standards

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Methodology

• Rapid Assessment
• Population samples
• 11 provincial hospitals (4 from Luzon, 3 from
  Visayas, and 4 from Mindanao) 6 are categorized
  as level 3 facilities 5 are level 2 facilities
• 10 district hospitals (4 from Luzon, 2 from
  Visayas and 4 from Mindanao) 7 are level 2
  facilities and 3 are level 1 facilities
• Survey using Benchbook criteria
• Percentage of compliance full, partial, none
• Percentage of applicability of the partial and
  non-compliance to the hospital setting

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Presentation of results

• Percentage compliance to the Benchbook criteria,
  Provincial Hospitals, 2007

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Presentation of results

• Percentage compliance to the Benchbook criteria,
  District Hospitals, 2007

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Presentation of results

• Reasons for partial and non-compliance to the
  PhilHealth Benchbook standards

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Presentation of results

• Policies and procedures not written, not
  monitored
• Organizational processes lack of planning,
  implementing, managing, monitoring, evaluating,
  informing/feedbacking/reporting, and completing
  requirements
• Structural components lack of forms,
  deficiencies in patient rooms, passageway,
  directional signs, information on services,
  equipment maintenance, program/management
  structures and plans, record keeping,
  agreements/contracts, relevant licenses, and
  resources
• Human resource factors deficiencies on
  qualified personnel, training, team processes,
  skill mix, capability, recruitment, selection,
  appointment, training, roles and responsibilities
  
• Patient aspects deficiencies in patient
  involvement in health, understanding of their
  roles and responsibilities, how they are
  accommodated to access services, patient safety,
  and observing patient rights.

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Presentation of results

• Percentage applicability of partial and
  non-compliant criteria to the Provincial
  Hospitals, 2007

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Presentation of results

• Percentage applicability of partial and
  non-compliant criteria to the District Hospitals,
  2007

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Presentation of results

• Criteria not applicable to hospital setting and
  reasons for non-applicability

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Recommendations in addressing the gaps

• Organizing the quality management structure
• Quality TWG / Quality Circle
• Identification of QC roles and responsibilities
• Integration of QC in the organizational chart

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Recommendations in addressing the gaps

• To deal with ownership and organizational issues,
  the Quality Circle is guided by
• Buying-in after the orientations
• Putting local flavor to Benchbook standards
• Working on existing structures and resources
• Capacity building for leadership and Quality
  Circle
• Advocating quality culture view QAP as program
  of self-assessment and development, not a program
  of requirement

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Recommendations on addressing the gaps

• 2. Writing the Manual of Quality Policies and
  Procedures
• The Manual serves as a reference document and
  guide for the quality assurance program of the
  hospital
• The Manual contains
• Vision-Mission statements
• General Organizational Quality Policy and Quality
  Goals
• Quality Policies and Procedures for (1) the
  Benchbook standards and (2) the clinical and
  non-clinical service areas
• Monitoring and Evaluation Tool Indicators,
  Targets, Document Source, Responsibility and
  Monitoring Frequency

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Recommendations on addressing the gaps

• 3. Other recommendations (supporting structures)
• PHIC
• Re-visit, re-validate, re-evaluate non-applicable
  standards and criteria
• PRO
• Continuous advocacy to implement Benchbook
  standards
• DOH
• National policy on quality integrating the
  internationally acceptable dimensions of quality
  (e.g. effectiveness, efficiency, equitability,
  safety, accessibility, acceptability)
• CHD
• Training of trainers for quality management
  system of the Benchbook
• Monitoring and evaluation of QAP

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Conclusions (Over-all Messages)

• Feasible to operationalize the Benchbook
  standards and criteria
• Better understanding of partial and non-compliant
  areas as areas for improvement
• Guidance for capacity building (orientation,
  methods, tools) on quality assurance and
  continuous quality improvement to create quality
  culture
• Policy/ enabling environment
• Institutional/ organizational environment
• Human resources

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Thank you very much!